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Animal and cross-sectional epidemiological studies suggest that prenatal lead exposure is related to delayed menarche, but this has not been confirmed in longitudinal studies. We analyzed this association among 200 girls from Mexico City who were followed since the first trimester of gestation. Maternal blood lead levels were analyzed once during each trimester of pregnancy, and daughters were asked about their first menstrual cycle at a visit between the ages of 9.8 and 18.1 years. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) for probability of menarche over the follow-up period using interval-censored Cox models, comparing those with prenatal blood lead level ⩾5 µg/dl to those with prenatal blood lead <5 µg/dl. We also estimated HRs and 95% CI with conventional Cox regression models, which utilized the self-reported age at menarche. In adjusted analyses, we accounted for maternal age, maternal parity, maternal education, and prenatal calcium treatment status. Across trimesters, 36−47% of mothers had blood lead levels ⩾5 µg/dl. Using interval-censored models, we found that during the second trimester only, girls with ⩾5 µg/dl prenatal blood lead had a later age at menarche compared with girls with prenatal blood lead levels <5 µg/dl (confounder-adjusted HR=0.59, 95% CI 0.28–0.90; P=0.05). Associations were in a similar direction, although not statistically significant, in the conventional Cox regression models, potentially indicating measurement error in the self-recalled age at menarche. In summary, higher prenatal lead exposure during the second trimester could be related to later onset of sexual maturation.

Childhood intake of animal foods is associated with age at first menstrual period (menarche). It is unknown whether the micronutrients present in these foods could explain this association. Our objective was to investigate the associations of micronutrient status biomarkers in middle childhood with age at menarche. We quantified circulating Hb, ferritin, mean corpuscular volume, Zn, vitamin B12, erythrocyte folate and retinol in 1464 pre-menarcheal girls aged 5–12 years in Bogotá, Colombia, and followed them for a median 5·7 years for the occurrence and date of menarche. We estimated median age at menarche and hazard ratios (HR) with 95 % CI by levels of each biomarker with use of Kaplan–Meier survival probabilities and Cox regression, respectively. Median age at menarche was 12·4 years. Middle childhood Hb was inversely related to age at menarche whereas plasma ferritin was positively associated with this outcome in a linear manner. HR of menarche for every 1 sd of Hb (11 g/l) and ferritin (23·2 µg/l) were 1·11 (95 % CI 1·04, 1·18; P=0·001) and 0·94 (95 % CI 0·88, 0·99; P=0·02), respectively, after adjustment for baseline age, C-reactive protein concentration, maternal age at menarche and parity and socioeconomic status. The association with ferritin was stronger in girls aged 9–10 years at baseline. Additional adjustment for baseline height- and BMI-for-age did not change the results. We conclude that higher Fe status in middle childhood is related to later age at menarche whereas Hb concentrations are inversely associated with age at onset of menses.

Intrauterine exposure to the rainy season in the tropics may be accompanied by high rates of infection and nutritional deficiencies. It is unknown whether this exposure is related to the extrauterine timing of development. Our aim was to evaluate the relations of prenatal exposure to the rainy season and altitude of residence with age at menarche. The study included 15,370 girls 10 to <18 years old who participated in Colombia’s 2010 National Nutrition Survey. Primary exposures included the number of days exposed to the rainy season during the 40 weeks preceding birth, and altitude of residence at the time of the survey. We estimated median menarcheal ages and hazard ratios with 95% confidence interval (CI) according to exposure categories using Kaplan–Meier cumulative probabilities and Cox proportional hazards models, respectively. All tests incorporated the complex survey design. Girls in the highest quintile of gestation days exposed to the rainy season had an earlier age at menarche compared with those in the lowest (adjusted hazard ratios (HR)=1.08; 95% CI 1.00–1.18, P-trend=0.03). Girls living at altitudes ⩾2000 m had a later age at menarche compared with those living <1000 m (adjusted HR=0.88; 95% CI 0.82–0.94, P-trend <0.001). The inverse association between gestation days during the rainy season and menarche was most apparent among girls living at altitudes ⩾2000 m (P, interaction=0.04). Gestation days exposed to the rainy season and altitude of residence were associated with the timing of sexual maturation among Colombian girls independent of socioeconomic status and ethnicity.

The decline in age of pubertal timing has serious public health implications ranging from psychosocial adjustment problems to a possible increase in reproductive cancers. One biologically plausible explanation for the decline is a decrease in exposures to infections. To systematically review studies that assess the role of infection in pubertal timing, Medline, Web of Science and EMBASE were systematically searched and retrieved studies were reviewed for eligibility. Eligible studies examined the association between infections, including microbial exposures, and physical pubertal characteristics (breast, genitalia and pubic hair development) or age at menarche. We excluded studies that were published in a language other than English, focused on precocious puberty, were case studies, and/or included youth with autoimmune diseases. We report on study design, population characteristics, measurement of infection and puberty and the main effects of infection on pubertal development. Based on our search terms we identified 1372 unique articles, of which only 15 human and five animal studies met our eligibility criteria. Not all studies examined all outcomes. Infection was associated with later breast development (4/4 human studies), with less consistent evidence for genitalia and pubic hair development. Seven studies assessed age at menarche with inconsistent findings (three supporting later, four no association). We conclude that a small but consistent literature supports that infection is associated with later breast development; the evidence for other pubertal events and age at menarche is less clear. Where fewer childhood infections coincide with the rise in incidence of hormone-related cancers.

A review of the qualitative literature on young women's experiences of menarche revealed that menarche had a major impact on lives physically, psychologically, socially and culturally. Pubertal development before the age of eight and menarche before the age of nine should be investigated by an endocrinologist. Early menarche is associated with an increase in all cancer mortality, whereas late menarche is associated with increased risk of osteoporosis and fractures. Sometimes girls will continue to have heavy bleeding on combined hormonal contraception (CHC). A recent addition to treatment options is oestradiol valerate with dienogest (Qlaira) with a license to treat heavy menstrual bleeding. The authors have found it useful in the treatment of peri-menarchal dysfunctional uterine bleeding (DUB) and also useful for young girls who find it difficult to tolerate oestrogenic side effects including headache and nausea.

Early pubertal timing in girls is associated with elevated risk for dieting and eating pathology. The relative importance of biological versus socio-environmental mechanisms in explaining this association remains unclear. Moreover, these mechanisms may differ between objective measures of pubertal development and girls' subjective perceptions of their own maturation.

Method

The sample comprised 924 sister pairs from the National Longitudinal Study of Adolescent Health. Objective pubertal timing (menarcheal age), girls' perceptions of pubertal status and timing relative to peers, dieting and disordered eating behaviors were assessed during a series of confidential in-home interviews.

Results

Behavioral genetic models indicated that common genetic influences accounted for the association between early menarcheal age and increased risk for dieting in adolescence. In contrast, girls' subjective perceptions of their timing relative to peers were associated with dieting through an environmental pathway. Overall, subjective and objective measures of pubertal timing accounted for 12% of the variance in dieting.

Conclusions

Genetic differences in menarcheal age increase risk for dieting among adolescent girls, while girls' perceptions of their maturation represent an environmentally mediated risk.

Our aim in this study is to describe the characteristics of sexual development in twins and estimate the role of heritability and environmental factors as causes of certain sexual disorders. Two hundred and ten adult same-sex twin pairs (92 monozygotic [MZ] female, 41 MZ male, 55 dizygotic [DZ] female and 22 DZ male pairs) were involved in the study. Data were collected in 1982 by self-administered questionnaires that included items on sexual maturation, sexual life, contraception, mutual sexual activity within twin pairs and alcohol use. The ratio of married to unmarried twins was nearly the same in MZs and DZs, with the exception that the divorce rate was higher in MZ female twins (14%), and DZ and male twins were slightly more likely to be single. Menarche was later in twins compared to non-twin Hungarian women. 57% of MZs experienced menarche within 3 months of each other, 77% within 6 months while it occurred for 30% and 43% respectively in DZs. The first seminal emission indicated some delay in male twins compared with the Hungarian general population sample. MZ first kisses occurred later than DZ's first kisses. The same was true for the first petting, masturbation and first sexual intercourse. Anorgasmy is 27% heritable but the estimate is not statistically significant. Concordance rate for premature ejaculation in MZs was greater than in DZs but the structural equation model showed significant misfit. Age at menarche appeared to be strongly heritable.

To investigate associations between dietary intakes throughout childhood and age at menarche, a possible indicator of future risk of disease, in a contemporary cohort of British girls.

Design

Diet was assessed by FFQ at 3 and 7 years of age, and by a 3 d unweighed food diary at 10 years. Age at menarche was categorised as before or after 12 years 8 months, a point close to the median age in this cohort.

Setting

Bristol, South-West England.

Subjects

Girls (n 3298) participating in the Avon Longitudinal Study of Parents and Children.

Results

Higher energy intakes at 10 years were positively associated with the early occurrence of menarche, but this association was removed on adjusting for body size. Total and animal protein intakes at 3 and 7 years were positively associated with age at menarche ≤12 years 8 months (adjusted OR for a 1 sd increase in protein at 7 years: 1·14 (95 % CI 1·04, 1·26)). Higher PUFA intakes at 3 and 7 years were also positively associated with early occurrence of menarche. Meat intake at 3 and 7 years was strongly positively associated with reaching menarche by 12 years 8 months (OR for menarche in the highest v. lowest category of meat consumption at 7 years: 1·75 (95 % CI 1·25, 2·44)).

Conclusions

These data suggest that higher intakes of protein and meat in early to mid-childhood may lead to earlier menarche. This may have implications for the lifetime risk of breast cancer and osteoporosis.

This chapter presents a a discussion on children and mothers. The observed distribution of age of onset of menopause is a mixture of two distributions; one distribution is normal with an early age of menopause around 40, and other one is normal with a mean age around 50. If the mother had a very early age menopause, the person is more likely to be in the earlier distribution. There is a third group of women that had hysterectomy. A series of competitive risks analyses and work is performed on hysterectomy because these women already have high risk of cardiovascular disease. There is no relationship between the age of menarche and menopause. Women think that if they started their periods early, they will finish early. The stigma is with the child rather than on the parents themselves. When the children go to school the parents were being mistaken for grandparents.

Reproductive health, from menarche to menopause, is not only understood as integral to women's overall health and wellbeing but is increasingly recognised as a sentinel of chronic disease in later life. The changing patterns of reproductive function are explained with regard to trends in child bearing. The difficulty in conceiving naturally for those women who delay childbearing may have also contributed to the increased use of assisted reproductive technologies (ART) such as in vitro fertilisation. The rise in popularity of these treatments over the past two decades reflects both the increasing demand for fertility treatments but also their wider acceptability and availability. To predict future trends in chronic disease for women based on their changing patterns of reproductive characteristics, the risk factors linked to reproductive health and health in later life to be considered are: obesity, hormone therapy use, and other risk factors such as social inequalities.

Information about menstrual cycle variables was obtained by questionnaire using 462 female twin pairs. The twins were either members of the Institute of Psychiatry Volunteer Twin Register, or of the Birmingham Population-based Register. The two samples were analysed separately using univariate and multivariate methods so that an independent replication was obtained. Maximum likelihood estimation was used to fit simple models of genetic and environmental variation to these data. The results suggest that age of menarche, menstrual cycle regularity and premenstrual symptom reporting may be heritable, whereas menstrual cycle length is not. The results should be interpreted with caution as not all variables were replicated in the smaller sample, and the method of retrospective menstrual cycle data collection has been questioned.

Mothers of twins, as compared with mothers of singletons, are taller, and for a given height are heavier; they have slightly earlier menarche and menopause. Our recent studies have shown that mothers of DZ twins are at greater risk of cancer of the pancreas (but not for cancers of other sites), as well as of death due to diabetes, other endocrine diseases, and allergies. These findings are consistent with the clinical and epidemiological literature. We have also found that singleton siblings of twins are slightly heavier at birth than children born into sibships consisting of singletons only. The need for further research on the characteristics and long-term health of mothers of twins is indicated.

An evaluation of the maternal effect on spontaneous abortion and the genetic contribution to various reproductive variables was made using like-sexed twins born between 1915–1946. Health and reproductive questionnaires were sent to 2,365 twin pairs listed in the Norwegian Twin Registry. Zygosity was determined by a questionnaire which proved to be 98% accurate in discriminating between monozygotic (MZ) and dizygotic (DZ) twins. Verification of the zygosity questionnaire was accomplished by blood cell marker zygosity determination in 200 twin pairs. Data from 428 monozygotic twin pairs (174 male pairs and 254 female pairs) were analyzed by a new model for qualitative traits and a striking maternal effect was found. The results suggested that over 54% of all women may belong to a high risk group who have approximately a 13% risk of early fetal loss. The incidence of first trimester abortions and spontaneous abortion reported by a sample of 915 like-sexed twin pairs and spouses was .079 and .089, respectively; there were no significant differences between male and female pairs.

Other reproductive variables were studied in both MZ and DZ twins including the age of menarche and menopause, the age at marriage and birth of the first child, and the interval between marriage and the first birth. These variables were examined for evidence of genetic effects and secular trends. The mean age of menarche had decreased significantly between the years 1915–1935 and 1936–1946. The secular trend appeared to be environmental in nature and accounted for more than 7% of the overall variation in age of menarche. Sixty-five percent of the variation in the age of menarche was attributed to genetic factors. The mean age of marriage and the mean age at the first birth decreased significantly between 1915–1935 and 1936–1946. Twins born between 1936–1946 also reported fewer pregnancies than did twins born between 1915–1946, but this was statistically significant among MZ twins only; no significant difference in the frequency of spontaneous abortions was found between the 1915–1935 and the 1936–1946 groups.

Although there were occasional groups in which differences were statistically significant, no general trends were identified in comparing couples who reported a spontaneous abortion with those who did not. Traits compared were: the age of menarche, age of marriage, age at first birth, the interval between marriage and first birth and the mean present age of the twins and spouses. Couples reporting a first trimester spontaneous abortion had significantly more total pregnancies than those not reporting a spontaneous abortion. Unaffected pregnancies were also significantly more numerous in couples with a spontaneous abortion compared to those without, suggesting over-compensation for fetal loss.

A maternal effect in spontaneous abortion was indicated by the correlation coefficients found; significant positive correlations were found in both MZ and DZ females but not in males. For total pregnancies and unaffected pregnancies, MZ twins, both male and female, had significant correlation coefficients while DZ twins did not.

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